Why this topic matters
Jaw pain, clicking when opening the mouth, difficulty chewing, facial pain, neck tension and headaches (including migraines) are common and often interrelated complaints. In many cases, the origin may be related to the temporomandibular joint (TMJ) and the set of conditions known as temporomandibular disorders (TMD).
The good news: when properly assessed, these complaints tend to be understood and treated with safe, evidence-based strategies.
What is the TMJ (and why it can hurt)
The TMJ is the joint that connects the jaw to the skull and participates in essential functions: speaking, chewing, yawning, and swallowing. It is a complex joint with bone and muscle components and an articular disc. Therefore, changes in function, overload, or sensitisation can result in various symptoms.
Pain can manifest as:
- pain in the jaw (in front of the ear)
- pain when chewing, yawning or talking for a long time
- feeling of facial fatigue
- clicking or crackling sounds
- limited mouth opening or ‘locking’
- pain referred to the head, ear, face and neck
The international classification emphasises that orofacial pain can have various origins and must be strictly classified. The International Classification of Orofacial Pain provides this diagnostic framework.
TMD: an umbrella term for different situations
TMD is not a single diagnosis. It is a term that groups together different conditions, mainly:
- Muscle-related TMD (e.g., pain in the masticatory muscles)
- Joint-related TMD (e.g., disc changes or inflammation)
In clinical practice, one of the most widely used models for diagnosis and investigation is DC/TMD, which organises clinical criteria and also integrates relevant psychosocial dimensions.
Teeth grinding or clenching: bruxism and overload
Many people immediately associate ‘teeth grinding’ with TMD. It is true that bruxism (especially at night) can contribute to muscle and joint overload, but the relationship is not ‘automatic’ or the same in everyone.
The most useful way to look at this is:
- bruxism may be a contributing factor, not necessarily the primary ‘cause’
- stress, sleep, habits and nervous system sensitivity can influence symptoms
- the clinical focus is not to ‘blame the tooth’, but to understand the pattern of overload and the context
The link between TMJ, neck and headaches
Neck pain and tension in the trapezius muscles often coexist with TMJ pain. This is not surprising: the head, jaw and cervical spine function as an integrated system.
In addition, many people with TMD report recurrent headaches. To accurately classify headaches, there is a specific international classification - the International Classification of Headache Disorders (ICHD-3) - which is essential for distinguishing patterns and guiding clinical approach.
This point is important because not all headaches are the same, and the assessment must respect clinical signs and individual history.
‘The pain is real’ (even when the examination shows ‘nothing serious’)
Contemporary science describes pain as a sensory and emotional experience, associated with or similar to that associated with tissue damage. This definition was revised by the International Association for the Study of Pain (IASP) in 2020.
This helps to understand why:
- the intensity of pain can vary greatly between people
- stress and sleep can amplify symptoms
- imaging (X-ray/MRI) does not always explain everything
- care needs to be person-centred, with clear explanations and progressive strategies
How physiotherapy can help (evidence-based approach)
Physiotherapy for TMD tends to be based on pillars such as:
- education and pain literacy (explaining clearly, reducing fear, adjusting expectations)
- therapeutic exercise (jaw and cervical, progressive and adapted)
- self-regulation strategies (jaw relaxation, breathing, habit pausing)
- manual techniques when appropriate, as a complement and not as a sole solution
A recent systematic review suggests that manual therapy applied to craniomandibular structures can improve pain and mouth opening in people with TMD, although the quality and heterogeneity of the studies warrant cautious reading and individualisation.
When to seek further evaluation
Without causing alarm, it is worth seeking evaluation when there is:
- persistent blockage (‘the mouth won't open’)
- progressive severe pain, recent trauma, fever, marked swelling
- neurological changes (tingling/changes in facial strength)
- unexplained weight loss, persistent night pain without a mechanical pattern
- headache with neurological signs or sudden change in pattern
Final message
Jaw/TMJ pain, clicking, teeth grinding, facial pain, and headaches may be related, but they are rarely explained by a single cause. The most effective care is one that combines rigorous assessment, clear explanation, and progressive, individualised strategies.
At Physioclem, we take care of you naturally: with proximity, rigour and an integrated approach so that you can eat, speak, sleep and live with greater comfort and confidence.
References
International Classification of Orofacial Pain (ICOP), 1st edition. Cephalalgia. 2020;40(2):129–221. doi:10.1177/0333102419893823.
Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications. J Oral Facial Pain Headache. 2014;28(1):6–27. doi:10.11607/jop.1151.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1–211. doi:10.1177/0333102417738202.
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982. doi:10.1097/j.pain.0000000000001939.
Asquini G, Pitance L, Michelotti A, Falla D. Effectiveness of manual therapy applied to craniomandibular structures in temporomandibular disorders: a systematic review. J Oral Rehabil. 2022;49(4):442–455. doi:10.1111/joor.13299.
Singh BP, Singh N, Jayaraman S, Kirubakaran R, Joseph S, Muthu MS, et al. Occlusal interventions for managing temporomandibular disorders. Cochrane Database Syst Rev. 2024;9(9):CD012850. doi:10.1002/14651858.CD012850.pub2.
